2025 Ink'd Cosmetics Consent Form

I have truthfully represented to Ink'd Cosmetics that I am over eighteen (18) years of age.

I give my permission to Ink'd Cosmetics to use, re-use, publish any photographic portraits or pictures of me.

Are you under the influence of alcohol or drugs?

Are you pregnant or breastfeeding?

Are you free of any communicable disease(s)?

Are you susceptible to herpes infection breakouts?

Are you diabetic, have any bleeding disorders or cardiac valve disease?

If yes, please list here:

Any acne, freckles, moles, or suburn in the area(s) to be tattooed?

Have you been on Accutane in the past 12 months?

Botox, lip fillers, chemical facials, retinol, Retin-A?

If yes, please list the name(s) and last date(s) of treatment(s):

Please list history of long term medication usage(s) and current medication usage(s) This includes antibiotics prescribed prior to dental and surgical procedures:

I agree to have the following PMU procedure(s) performed on me: Powder Brows (Ombre included), Satori brows, Correction, Lash enhancement, Eyeliner Top/Bottom, Decorative Eyeliner Top/Bottom, Lip Blush, Lip Neutralization, Camouflage, Inkless Stretch Mark Revision

Selected Procedures:

Total rates:

Agreement of Follow Up on Brows: The rate of $150 is good within 6 months of initial session. *Follow up session within 6 months for Eyeliners & Lips are included with initial Full Rate.

I, have been fully informed of the risks of PMU tattooing but not limited to infections, scarring, hypo/hyperpigmentation of skin, any allergic reactions to tattoo pigments, numbing agents, latex gloves, & antibiotics. Having been informed of the potential risks associated with getting a tattoo, I still wish to proceed with the PMU tattoo application and I assume any and all risks that may arise from tattooing.
It is not reasonably possible for an Artist of Ink'd Cosmetics to determine whether I might have an allergic reaction to the dyes, pigments, or processes used in my tattoo and I agree to accept that such risks are possible. The variations in color and design may exist between any tattoos I selected and applied to. Permanent Makeup/Tattooing is a permanent change to my appearance and that no representations have been made to me as to the ability to later change, alter or remove my tattoo. Obtaining of my PMU tattoo is my choice alone and I consent to the application of the tattoo and to any actions or conduct of Ink'd Cosmetics that are reasonable necessary to perform the PMU tattoo procedure. Tattoo inks, dyes and pigments have not been approved by the FDA and the health consequences of using these products are unknown. Infection is always possible as a result of obtaining a PMU tattoo. I agree to follow all instructions concerning the care of my PMU tattoo, and that any follow up appointments needed because of my own negligence will be done at my own expense. A receipt of written instructions advising me of proper care of my PMU tattoo acknowledges the absolute necessity of following those written instructions.

By signing this release form I have been given the full opportunity to ask any and all questions I might have about obtaining a PMU tattoo from Ink'd Cosmetics. I acknowledge that all my questions have been answered to my full and total satisfaction.

Full Name

DOB

Address

Street Address Line 2

City/State

Phone/Text#

Email address

example@example.com

Client Signature

Date

Artist Name: Print/Signature

PERMANENT MAKE-UP/TATTOO CONSENT FORM

Client Information